Sequential Combined Treatment with Lamivudine and Interferon Alfa in Young People with Chronic Hepatitis B
So far there is no effective treatment for HBeAg positive individuals with a high HBV viral load and low alanine aminotransferase (ALT) levels. To address this, researchers evaluated whether priming lamivudine (Epivir-HBV) treatment might enhance the antiviral and immunostimulant action of lamivudine in combination with standard interferon alfa (IFN) in young tolerant patients.
Eleven chronic HBeAg positive patients received: 100 mg/day lamivudine for 3 months followed by IFN 5 MU/m2/tiw with lamivudine 100 mg/day for 6 months and then lamivudine alone 100 mg/day for 9 months.
Quantitative hepatitis B virus (HBV)-DNA was evaluated during treatment and core-promoter, precore and polymerase HBV mutants were detected by direct sequencing at the end of therapy.
Serum HBV-DNA levels dropped during lamivudine monotherapy and in combination with IFN.
After IFN withdrawal, viremia transiently increased to high levels in five of 11 (45%) patients who showed rt M204V/I lamivudine mutant resistant.
Two patients cleared HBeAg without anti-HBe seroconversion. One patient presented core-promoter and precore stop codon mutations.
Conclusions
Three-phase sequential combined lamivudine/IFN treatment reduced HBV-DNA serum level, but did not lead to HBeAg and HBV-DNA clearance in these highly viremic, normal ALT patients. Lamivudine/IFN combination did not prevent the emergence of YMDD lamivudine resistance.
The authors conclude, 揘ew schedules of antiviral treatments must be evaluated in this population at risk of disease progression.?/span>
04/01/05
Reference
N H Park and others. Monitoring of HBeAg levels may help to predict the outcomes of lamivudine therapy for HBeAg positive chronic hepatitis B. Journal of Viral Hepatitis 12(2): 216-221. March 2005.
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发表于 2005-4-3 02:24
